Get involved Top 4 issues facing the osteopathic profession—and actions to take These are the profession’s most pressing affairs right now, says AOA President John Becher, DO, who offers tips on how DOs can make an impact. Sept. 17, 2015Thursday Rose Raymond Contact Rose Facebook Twitter LinkedIn Email Topics advocacyosteopathic medicineprofessional development AOA President John W. Becher, DO, wants to see more DOs involved in advocating for, championing and shaping the osteopathic profession. To assist them, he has outlined the most critical issues the profession is facing right now, along with steps DOs and students can take to make a difference. The evolving US health care system Since it was signed in 2010, the Affordable Care Act has completely transformed the health care landscape. Some changes, such as the increase in the number of insured Americans, have been beneficial. Other changes, such as the establishment of the Independent Payment Advisory Board, have the potential to be burdensome to physicians and patients, Dr. Becher says. What you can do: “Physicians cannot be silent as the ACA continues to be implemented,” Dr. Becher says. “They have to be prepared to actively participate with their legislators in reformulating and tweaking the law for the benefit of all participants and providers in the health care system.” Dr. Becher urges DOs to write to their representatives to share their opinions on the implementation of the law or, better yet, to meet with them. Life after SGR: Value-based payment The April repeal of Medicare’s sustainable growth rate formula was a major win for physicians, many of whom had been frustrated by the uncertainty of constantly looming rate cuts for more than a decade. Now, Medicare is tasked with developing a new system of physician payment that rewards quality of care over quantity. Physicians can and must play an integral role in the implementation of the new payment model, Dr. Becher says. What you can do: “Who better perceives quality care than the physicians who are providing it?” Dr. Becher says. “Physicians need to be involved in determining what the quality parameters are for the new formulas for payment of physicians.” Stay up to date on Medicare developments and share your feedback and expertise with lawmakers, Dr. Becher suggests. Osteopathic recognition and identity With the AOA getting ready to roll out a multi-year national osteopathic awareness campaign, the osteopathic medical profession is poised to go prime time. But DOs and medical students shouldn’t sit on the sidelines as this happens. Related What you can do: In his inauguration speech, Dr. Becher asked DOs and students to take three to five minutes every week to educate a new person on osteopathic medicine and DOs. “We have to take ownership in promoting ourselves,” Dr. Becher says. “We should all stand up and be proud of our profession and what it stands for.” Dr. Becher also wants to hear from DOs and students. What makes you proud to be a DO or a future physician? Post a video on the AOA’s social media pages or send your testimonial to touchpoint@osteopathic.org. The single graduate medical education accreditation system In the past year, the profession has made great strides toward a successful transition to a single GME accreditation system, Dr. Becher notes. For instance, 22 of the 24 residency review committees have announced they will accept AOA certification for program directors. But as the profession continues working on this new system, feedback from DOs, residency program directors and medical students will be critical, Dr. Becher says. What you can do: Stay informed on the latest single GME developments: Watch for news in your inbox from The DO and AOA Family Connections, or check the AOA’s single GME Web page. Provide feedback and share your thoughts by emailing the AOA at SingleGME@osteopathic.org. Follow the transition closely, and let leadership know what’s working well and what needs to be improved. Previous articleWatch: Advisory committee recommends 4 vaccines for adolescents Next articleIn Memoriam: Sept. 18, 2015
Dump Cranial and Chapmann’s Points. Rid the curriculum and board examination of these dubious elements. Sep. 21, 2015, at 7:39 pm Reply
As the current standard for medical knowledge is founded in evidence based data, please refrain from teaching and testing on anecdotal topics. This is quite laughable and ridiculous. Sep. 22, 2015, at 6:25 pm Reply
I am assuming that the above comments are from OMS’s. That being the case, OMS’s have never had to really take care of patients for a prolonged period of time and seen all of benefits and the drawbacks of supposed EBM. We, practicing physicians, are constantly doing things that are not EBM, and what is EBM one year is not EBM the next. A lot of times we are finding our way in the dark with little to guide us except “anecdotal” information. S.O, D.O. (Physician Anesthesiologist) in Tucson, AZ Sep. 22, 2015, at 8:03 pm Reply
Well said regarding EBM. I would never let EBM get in the way of helping my patients acheive better health. And as always, if learning something about Chapman’s points or cranial is not what you wanted in med school, don’t apply to an osteopathic program. Sep. 24, 2015, at 8:35 am
With the upcoming merger with ACGME the one thing that really sets us apart–osteopathic GME training–is essentially gone. By focusing our identity on manipulation and the dubious “osteopathic approach to (Katrina, 9-11, etc) ” over the years we tried to make ourselves seem more different than we really are. We ARE different, but I find it hard to define. I became a DO because I like the more holistic, human approach to care that is common in our smaller, community hospitals. I liked being mentored by a group of doctors who are truly dedicated to their patients and connect with them. I like the camaraderie of our profession. Having taught in an MD training program I found it stifling and rigid. I went back to a smaller community hospital. Is what we “do” different from an MD? Not necessarily. It’s how we are trained that is different. When the answer to the question “what is the difference between an MD and a DO?” is “essentially nothing,” then our reason to exist is gone. I hope I am wrong. Sep. 22, 2015, at 7:19 pm Reply
There is no “tweaking” to the illegally passed (forced on us), un Constitutional “law” known as Obamacare. To call it the “Affordable Care Act” is a complete Goebbels style misnomer. This law is fundamentally wrong, down to every last word. And it’s a complete lie by the administration and the AOA to say that it has increased the number of insured. The facts say otherwise. The AOA became irrelevant when it ignored its membership and our patients, as well as the American People and the rule of law in supporting it. Shame on you for supporting it, and shame on you for continuing to be lying shills, AOA! Sep. 22, 2015, at 7:40 pm Reply
Stop opening up so many schools that charge ridiculous amounts of money who stop caring once you enter clinicals. Have legitimate residencies that have the patient load and staff that actually want to teach, not just do it because they are there. Stop allowing residencies to open up at every community hospital that is under staffed, not qualified to take medical students yet alone 15 different residencies in things like dermatology and ophthalmology. I am proud that I am a DO, but I am not proud about how things are being run and until those things change, I know very few people who will be proud of their medical school and remain a part of it after their training. The way things are going, DO will become more and more like IMG training. Sep. 22, 2015, at 8:02 pm Reply
Not an OMS, but a practicing DO at major academic institution. I agree with the above posters, scrap Chapman’s and Cranial. These dubious elements are holding our profession back. DO must no longer be akin to solely family practitioners at community hospitals. We need to recognize our colleagues in primary care AS WELL as our sub-specialist colleagues at major research institutions. We need to stem the tide of brach campuses opening on every corner. We have some waking up and some soul searching to do. SJ Sep. 22, 2015, at 9:13 pm Reply
Agreed. Branch campuses are a plague! Little more than revenue centers disguised as medical schools with insufficient infrastructure and laughable clinical site availability. Sep. 23, 2015, at 8:53 am Reply
I have lived and practiced in four countries in three continents in the last fourty years. Osteopathic Manipulative Medicine is VERY useful and in high demand. Especially cranial sacral as it is so gentle and so deep acting within ones internal medicine system. The policy actions of the AOA have not always supported the differences between the AOA and AMA. Ignoring the differences between DO and MD and also the DO distinctiveness is foolish. If you want to help a patient don’t just be an ordinary doctor be a DO and start thinking for yourself as you make the patient your primary concern Sep. 23, 2015, at 4:37 am Reply
I forgot who said this but they said it well! ” Hippity,Hoppity, Osteopathy” Sep. 23, 2015, at 7:31 am Reply
Look out DO’s as the AOA has joined with the MD’s re: Residency Programs Our graduates are going to be quite eliminated by the MD graduates for the best programs now that the DO’s have given in to intimidation!!!!!!! It amazes me how people who forget history do repeat it. Remember California?!!!!!!!!!!! Sep. 23, 2015, at 8:25 am Reply
I would gladly fork over $60 to get an MD degree if it would distance myself even more from those quacks practicing cranial. Sep. 25, 2015, at 2:02 pm Reply
Totally agree with SJJ2727, I am also practicing at a large academic center. Craniosacral therapy is widely regarded as quackery; while I don’t completely agree with that, we spent an entire month on it as an OMS2, which is insane. It should be left to the OMT fellows and be heavily de-emphasized in the general curriculum. Let the whole-patient philosophy be the emphasis, not dubious treatments like these. As for the actual awareness campaign, social media is obviously a major target but what I’ve always felt would have a huge impact would be to try and get DO’s on TV more. By that I don’t mean we need an osteopathic Dr. Oz (though getting someone on a show like “The Dr’s” is not a bad idea) but rather prime-time medical dramas. You don’t need to make a whole episode on it, no producer would go for that, but just have a few characters clearly identified as DO’s on their coats, office doors, etc. Sep. 23, 2015, at 8:49 am Reply
Indeed it behooves the AOA to attempt to control the discussion by identifying these four issues. For many DOs, however, the biggest issue is that of OCC. Our MD colleagues face this same scam – and a scam is what it properly should be called. Some of the more pro-active MDs have formed the National Board of Physicians and Surgeons (NBPS – an “offshoot” of the AAPS) in order to provide legitimate board certification alternatives to the various ABMS boards. We should remember that these boards (ABMS and AOA) are corporations, which, though they may be defined as not-for-profit, are anything but. What exactly is it that should give these boards a monopoly in this area? At this time the NBPS cannot certify those currently caiught in the AOA-OCC scam, but they are friendly to our plight. I recommend that DOs who recognize this for what it is investigate nbpas.org. Under the FAQ tab is the following statement, “We get daily questions from the D.O. community asking to be added. Currently, we can certify D.O.’s if they are/were previously certified by an ABMS member board. There are a number of political and technical challenges in adding AOA certified physicians. D.O. physicians. We believe the best approach is to get a group of leading D.O. physicians together, to form a D.O. board. We are working on this and have reserved the domain, NBOPAS.org. Once we have a board established we can duplicate the NBPAS infrastructure to create the NBOPAS. If, in the future we have a merger of ABMS and AOA boards, then we could easily merge our boards. For now we are looking for D.O. leaders to volunteer for the NBOPAS board.” Let those of us who have had enough of this nonsense do what we can to join together and create legitimate boards that truly serve the interests of both physicians and patients. Sep. 23, 2015, at 9:20 am Reply
Dump Cranial and Chapman’s? Why not dump all of OMT? Should we not leave that job to the physical therapists? If we are all concerned about what is EBM, then OMM has no purpose in the armamentarium of modern day physicians. If OMM does not define us, then what does it matter if we become more and more like our allopathic colleagues? We all want to care for the “whole” patient…. Sep. 23, 2015, at 1:14 pm Reply
I’m an OMS1 right now. Reading comments about OMT, and the lack of usefulness in EBM is disheartening. Also it seems DOs are looked down upon because of faithful adherence to strange, and lacking strong evidence, OMT treatments. The more and more I interact with DOs in the real world, the more and more obvious their hatred of OMT becomes, most don’t use it and make it seem like it’d be better off for patients and physcicians alike to just scrape the DO, and convert it all into MD. This whole thing makes me sad, and makes me want to stop learning OMT, and to just do enough to fool my teachers and get the A… Sep. 23, 2015, at 1:43 pm Reply
Kyle: Things will look different when you begin practicing. Much of what seems important to you now will not matter then. You will learn just how much of actually treating patients is art and how much is science. Forget your concern about EBM. Sit back and watch your patients appreciate OMT. I must say that I do not envy you entering the field at this time, but if you decide to continue, don’t follow the crowd. Sep. 23, 2015, at 2:55 pm Reply
What about the field now do you not envy? It seems more doctors are needed now than ever before… Sep. 23, 2015, at 3:36 pm
Answer to your question below. There is more to it than simply “need.” I’ve been in practice nearly 30 years. The EMR has devastated doctor-patient interaction. Insurance companies and myopic cubicle-denizens run the show. Scams like the AOA OCC joke. I could write pages. Lots of dissatisfaction. Much of my generation retiring early. I honestly wish you good fortune. Sep. 23, 2015, at 3:57 pm
Well I hope I can weather the storm. My situation is different than most, my mother died when I was in college and left me a large inheritance that will pay for my education. I will start with no debt. I honestly want to assist people in being well, and make a semi-comfortable living well into my 60s. Regardless of the EMR or OCC, I belive medicine a vehicle to which I can look back upon my life and be proud that however small my mark was, I changed someone, I helped someone. That is all I want. Thank you for your input and hope all is well in Texas. PK OMS1 in Ky Sep. 23, 2015, at 5:54 pm
Kyle, I’ve been out of training only a few years. there are many challenges. HOWEVER, the future can still be bright. Don’t let go of OMT yet. I find much of the bias (MDs and DOs) against OMT has come from poor explanation of what OMT is or what it does. Know your anatomy and explain OMT from a physiologic standpoint. When you can explain OMT in those terms you will gain acceptance. Some phsycians will never be happy with your explanation, but patients will, and the WILL find you and recognize the difference your hands-on approach to medicine will make. I’ve work in a large academic institution with well over 90% MDs and our OMT consult service averaged 30+ patients a day. I now work at a dually accredited residency program and have been asked by the director (MD) to teach OMT to both the DOs and MDs as he recognizes the need for a solid anatomic and physiologic foundation, regardless of previous training. For a DO that sets himself/herself apart as knowledgable and different that future will always be bright. Sep. 24, 2015, at 8:51 am
I say make admissions to Osteopathic Medical Schools more stringent – if you are not there to learn how to be a complete and competent Osteopathic Physician, then apply to an MD Schools. Comments like the ones above which disregard the validity of OMT are ignorant and disappointing. True, Manipulation is an integral part of who we are as D.O.’s but it does not define us – our osteopathic principles and philosophy does. Osteopathic Physicians who ‘get it’ wouldn’t make comments such as “dump cranial” or “evidence based medicine” only. It reflects also upon the quality of the OMT dept at their medical schools and attending physicians during their clinical years, so perhaps it is not entirely their fault we have DOs who do not know what they stand for. So yes — Osteopathic Medical Schools, accept students who are there to learn how to be Osteopathic Physicians. If you only want to be an MD, go to an MD school. Sep. 23, 2015, at 2:11 pm Reply
Agree. As a new assistant program director I’m in my first go-around with residency applicataions. The DO applicants have such a wide variety of 3rd and 4th year clinical rotations and some of them show up for rotation here appearing very weak. These students are often coming from either branch schools or newer schools. Any combination of poor teaching (especially with OMT), small community-only clerkships and typically poorer academic performance prior to med school seem to be plaguing the students from those programs. Sep. 24, 2015, at 9:12 am Reply
JG, DO hit the nail on the head. I’m a resident (and the sole DO in my class) at an ACGME University IM program. One of the programs I interviewed at stated I was the only DO they were interviewing that year. When I asked why they didn’t really interview DO’s, they said it was not that they had doubts about their preclinical training (there are many many DO’s who score highly on the USMLE Step 1), but they had serious concerns about their clinical competency starting internship if the majority of their clinical training came from small community hospitals or clinic based preceptor experiences. The (relatively) poor clinical training available to DO students is what really holds the current generation of DO’s back. I wish that this was priority number 1. The older, more established DO schools do have pretty strong clinical training sites, but on the whole, the model of preceptor based training, and training in small community hospitals, is viewed as a detriment by some PD’s in the more competitive residency programs. Sep. 24, 2015, at 11:29 am
I posed the earlier questions on dumping OMT in order to spur discussion. I am a physician anesthesiologist and I incorporate OMM into both my preoperative and postoperative care. I also have treated staff and surgeons with OMT as well. My, mostly allopathic partners, helped me set up our billing department to help me bill OMM. I also worked with the IT department of my hospital to set up an EMR EPIC template to help me chart an OMM treatment in just a couple of minutes. All of patients are pleasantly receptive and they feel like they are getting distinctive care. I have also treated many surgeons and fellow anesthesiologists, and many of them had had dramatic results with just a few minutes of an OMM treatment. Anyone, in primary care, that bemoans EMR, reimbursement issues, and time should follow me around one day and see what a little “digging on” can do. Take it from me, I’m a “specialist” but I have found a way to utilize osteopathic philosophy and the utility of OMM in my practice. If any of the OMS’s reading this feel “sad” or “disheartened,” please feel free schedule a rotation with me and take pride in your profession. Many of my allopathic partners have commented that they wish they could have gone to an osteopathic school to gain the skills that have helped so many people in my sphere of influence. Sep. 23, 2015, at 5:41 pm Reply
Well said. I believe what we often here is the vocal minority who bemoan Osteopathic principles and practice, including OMT. My experience is similar with my MD residents and fellow attendings, stating they wish they had known about osteopathy prior to admission to their MD school. Competant DO’s will always make a difference and be accepted. SO, DO where do you practice? Also, love the “digging on” reference. Sep. 24, 2015, at 8:57 am Reply
I practice in Tucson, AZ. I am a partner of a large, private practice anesthesiology group that is contracted out with a community hospital here in town. As part of the initial step of integrating osteopathic manipulation into my practice, I gave a 20 minute talk to all of the hospital administrators on the utility and efficacy of osteopathic manipulation in hospital patients. It was well received, and I actually had one hospital administrator thank me for introducing this type of medicine into the hospital. Edyth Ashmore, DO collected 1200 case reports from the osteopathic profession and published them as supplements to the JAOA from 1904-1909. Interestingly enough, only 14% of these cases involved the treatment of musculoskeletal complaints! The majority of the treatments were for acute and infectious diseases. These were the days before antibiotics and expensive pharmaceuticals. It was these results that put osteopathic medicine on the map and rocketed the profession onto the world stage. Unfortunately, we are not being taught the efficacy of this modality in the schools. The students do not see this work being done on their rotations. That is why all of the premed students that follow me have to read John Lewis’s book entitled AT Still: From the Dry Bone to the Living Man. If you want to know the real history and philosophy of osteopathy, it is a must read. Also, the students that follow me will see me integrate OMM into pre and post-operative care. They will see me treat colleagues and other hospital staff in the hallways, locker room, and on benches throughout the hospital campus. I am also in the process of starting an osteopathic study group to help physicians brush up on their skills, learn tools to integrate it into their practices, and also serve to inspire our younger doctors. I am also educating MD’s who want to learn OMM as well. This may surprise some of you, but there are a growing number of MD’s who have asked me to teach them OMM. I intend to teach them palpation, diagnosis, and osteopathic treatment. Our study group will teach OMM, including the “quackery” known and osteopathy in the cranial field. OCF is not a different field all to itself. It’s is based on osteopathy; membranous ligament articular strains analogous to ligamentous articular strains like we see in back pain. Osteopathy is Osteopathy is Osteopathy. I also want to go after those that would seek to discourage young minds from going into medicine. Medicine has its challenges like reimbursement, Obamacare, work life balance, etc. However, this is life and every profession. Life is hard. I find that osteopathic medicine gives me a way to enrich my life, learn more about the human condition, learn about the body’s amazing capacity to heal, and serve my fellow man. If I could go back in time, I would apply to osteopathic school again and I would never look back. I am proud to be a DO. I am different from my allopathic colleagues in how I approach medicine. They respect me for my distinctiveness. Why are we scared to be different? Patient are looking for physicians that are well versed in medicine, skilled with their hands, open to listening, and always learning and looking for new ways to reach out to them. Never give up on them! Sep. 24, 2015, at 10:47 am
One more thing, anyone that wants to quit medicine because of challenges like EMR, Obamacare, and “OCC” show their weakness and lack of fortitude. We go into medicine to battle disease and serve our patients. This is hard work and we are constantly being bombarded with obstacles and challenges. We do it not because it is easy but because it is hard. Patients need physicians. Nothing in life is easy and to throw in the towel reveals the true lack of character within. “Cowboy Up” as we say in AZ. Fight the good fight! I will serve until my dying breath. Sep. 24, 2015, at 11:11 am Reply
Well said, and bravo. I’m in Virginia. If if were closer I’d have my residents looking you up. I’ve been working to dispell the notion around here that OMT is only for MSK complaints. Sep. 24, 2015, at 11:57 am Reply
Well, SODO, you show no reluctance to draw firm conclusions based upon scanty information. Hopefully this propensity does not manifest itself in your diagnostic efforts. Sep. 24, 2015, at 1:52 pm Reply
Unfortunately, many of those who bash complementary medicine in this country, at their worst, have the mentality of religious fundamentalism. They automatically refute any claims that CAM modalities like OMM can truly and empirically help a patient’s medical course. On the other hand, CAM at its worst, refutes “Western EBM, and considers itself the sole source for healing and treatment of a patient’s ills. There must be a balance and room to investigate the claims of all approaches to medicine. Therein lies the art and science of medicine. For example, look at the latest study from the University of Arizona: “In Vitro Cellular Response to Osteopathic Manipulative Therapy Provides Proof of Concept, According to Researchers The Journal of the American Osteopathic Association Study Documents Objective Measures Induced by Osteopathic Techniques CHICAGO—July 30, 2015— In vitro studies of the cellular effects of modeled osteopathic manipulative therapy (OMT) provide proof of concept for the manual techniques practiced by doctors of osteopathic medicine (DOs), according to researchers from the University of Arizona College of Medicine – Phoenix. The study data conclusively showed that biomechanical strain had profound and potentially clinically significant effects on several cellular processes, such as proliferation, apoptosis and cytokine production. Also, different strain direction resulted in differential effects on cell growth, morphology and IL-6 secretion.” Perhaps more research and funding should go into simple treatments like OMT. The younger docs, like myself, have not been jaded and “dissatisfied” with the system. We are emboldened to learn more, support osteopathic research, and we will not be discouraged by the naysayers. We will wait as the older and bitter members of a generation,that came before us, run from a career in medicine. Then the younger generation can take over and apply the best of both allopathic and osteopathic principles to our practices. Most of the bitter doctors that complain about the healthcare system are doing zilch to improve it. They collect their money, do their jobs, and never put themselves on the line to improve things. It is easy to criticize, complain, and throw in the towel. It’s another thing to be involved politically, give monetarily, and rise up to change how healthcare is delivered. Sep. 24, 2015, at 2:24 pm Reply
SODO, if you should develop shoulder pain from straining to pat yourself on the back, it will be good to know that you can turn to a colleague for some OMT. Sep. 24, 2015, at 3:36 pm Reply
The JAOA has an impact factor of 0.0 If OMM is so efficacious and backed by strong science, why aren’t its benefits and discoveries being published in other highly respected, peer reviewed journals? Publishing supportive OMM pieces in the JAOA is not going to help the cause. Sep. 25, 2015, at 10:39 pm
I thoroughly enjoy practicing techniques on patients for which I have no objective, non-anecdotal evidence. Next week maybe I’ll give them some drugs that I cooked up in my garage that seemed to be effective when I tested them on cells. Sep. 25, 2015, at 6:23 am Reply
DUMP OCC The NBPS has been trying to recruit five DOs to serve as an initial board in order to replicate the work they have done with MDs relative to establishing credible boards as an alternative, in our case, to the AOA boards with their OCC scam. If the reality of what this OCC really is has sunk in and you wish to take concrete steps to initiate boards that are physician-friendly please contact Amanda Blommaert, MHA, the Chief Operating Officer of the ABPS at this e-mail address: ablommaert@nbpas.org They have already reserved a website for the osteopathic counterpart of the ABPS. Sep. 25, 2015, at 11:24 am Reply
Fairly recent student perceptions and attitudes of cranial: https://cranialosteopathy.files.wordpress.com/2011/04/2011-cranial-survey-abridged-results.pdf Sep. 25, 2015, at 2:17 pm Reply
Can someone PLEASE tell me where to find a practicing DO that accepts insurance? I am desperate!!! May. 3, 2016, at 9:11 am Reply
Hi Jessica, You can search for DOs in your area on the AOA’s Doctors That DO website: http://doctorsthatdo.org Thank you. May. 3, 2016, at 1:35 pm Reply